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    Vestibular Folds (False Vocal Cords)

    Reviewed by our medical team

    Protect vocal cords.

    1. Overview

    The vestibular folds, commonly referred to as the false vocal cords, are paired mucosal structures located within the larynx. Unlike the true vocal cords (vocal folds), they are not directly involved in sound production but serve important protective and structural functions in the airway. The vestibular folds form the upper boundary of the laryngeal ventricle and play a key role in airway protection during swallowing.

    2. Location

    The vestibular folds are situated in the supraglottic region of the larynx, specifically:

    • Above the true vocal cords (vocal folds)

    • Extending from the thyroid cartilage anteriorly to the arytenoid cartilages posteriorly

    • Forming the lateral walls of the laryngeal vestibule

    Each fold is covered by mucosa and lies just above its corresponding vocal fold, separated by the laryngeal ventricle, a small recess between the two sets of folds.

    3. Structure

    Vestibular folds are composed of:

    • Mucosa: Covered by respiratory epithelium (pseudostratified ciliated columnar epithelium) or stratified squamous epithelium depending on location and use

    • Connective tissue: Contains fibroelastic tissue and the vestibular ligament, though lacking the vocalis muscle found in true vocal cords

    • Glands and lymphoid tissue: Rich in mucous glands and sometimes lymphoid aggregates, contributing to local immune defense

    They do not vibrate during phonation but can come together to aid in glottic closure under certain conditions (e.g., straining, coughing).

    4. Function

    While the vestibular folds are not essential for speech, they serve several important roles:

    • Airway protection: Prevent food or liquid from entering the trachea during swallowing by helping to close the laryngeal inlet

    • Support glottic closure: Aid in forceful closure of the glottis during activities like coughing, sneezing, lifting heavy objects (Valsalva maneuver)

    • Mucous secretion: Help moisten and protect the true vocal cords and underlying airway

    5. Physiological Role(s)

    In addition to their anatomical and mechanical functions, vestibular folds contribute to:

    • Reflex actions: Act as a trigger point for the laryngeal cough reflex when foreign particles contact their mucosa

    • Reservoir for lymphoid tissue: May participate in immune surveillance through mucosa-associated lymphoid tissue (MALT)

    • Airway sealing: Provide a second line of defense after the epiglottis to prevent aspiration during swallowing

    6. Clinical Significance

    Laryngitis and Edema

    Inflammation can involve the vestibular folds, leading to:

    • Swelling (edema)

    • Voice changes

    • Airway narrowing

    Though not essential for phonation, edema of the false cords may still contribute to hoarseness and discomfort.

    False Vocal Cord Hypertrophy

    Can occur due to:

    • Chronic inflammation

    • Compensatory use (e.g., in vocal cord paralysis)

    Results in a harsh, strained voice as false cords attempt to vibrate or compress the airway during speech. Managed with voice therapy or surgery.

    Vestibular Fold Masses

    Benign or malignant lesions (e.g., cysts, papillomas, carcinomas) may arise from the vestibular folds, presenting with:

    • Dysphonia (voice changes)

    • Airway obstruction

    • Foreign body sensation

    Diagnosis via laryngoscopy; treatment depends on pathology.

    Role in Vocal Cord Dysfunction (VCD)

    During episodes of paradoxical vocal cord movement, vestibular folds may be misused or co-activated. This can lead to inspiratory stridor, especially during exercise or stress, and is often misdiagnosed as asthma.

    Surgical Landmark

    In procedures involving the larynx (e.g., microlaryngoscopy or tumor excision), the vestibular folds help guide surgeons to deeper structures while avoiding injury to the true vocal cords.

    Did you know? Your nose helps filter out dust, dirt, and allergens from the air you breathe.